BACKGROUND AND OBJECTIVES: Increased central arterial stiffness is an emerging risk factor for cardiovascular disease. Acute aerobic exercise reduces arterial stiffness, while acute resistance exercise may increase arterial stiffness, but this is not a universal finding. We tested whether an acute resistance exercise program was associated with an increase in arterial stiffness in healthy young men. SUBJECTS AND METHODS: Thirteen healthy subjects were studied under parallel experimental conditions on 2 separate days. The order of experiments was randomized between resistance exercise (8 resistance exercises at 60% of 1 repeated maximal) and sham control (seated rest in the exercise room). Carotid-femoral pulse wave velocity (PWV) and aortic augmentation index as indices of aortic stiffness were measured using applanation tonometry. Measurements were made at baseline before treatments, 20 minutes, and 40 minutes after treatments (resistance exercise and sham control). RESULTS: There was no difference in resting heart rate or in arterial stiffness between the two experimental conditions at baseline. At 20 minutes after resistance exercise, heart rate, carotid-femoral PWV and augmentation index@75(%) were significantly increased in the resistance exercise group compared with the sham control (p<0.05). Brachial blood pressure, central blood pressure and pulse pressure were not significantly increased after resistance exercise. CONCLUSION: An acute resistance exercise program can increase arterial stiffness in young healthy men. Further studies are needed to clarify the effects of long-term resistance training on arterial stiffness.
Blood Pressure ; Cardiovascular Diseases ; Collodion ; Exercise ; Heart Rate ; Humans ; Male ; Manometry ; Pulse Wave Analysis ; Resistance Training ; Risk Factors ; Salicylamides ; Vascular Stiffness

PURPOSE: Philtral deformity is a stigma of secondary cleft lip nose. It occurs from the false arrangement of orbicularis oris muscle and the scar of previous operation. Various methods have been used to correct this deformity. We successfully corrected philtral deformity using overlapping of orbicularis oris muscle flap. METHODS: From November 2000 to August 2007, we performed 39 cases of correction of philtral deformity in secondary cleft lip nose with overlapping of orbicularis oris muscle flap. Their age ranged from 5 to 53 years old. Existing scar tissue of previous operation was deepithelialized and preserved as scar flap. Lateral orbicularis oris muscle flap was elevated, advanced and overlapped upon medial muscle flap after dissection of orbicularis oris muscle of both sides. Reconstruction of philtral column was made from overlapping area by fixation of end part of lateral muscle flap to the point between philtral dimple and column. The degree of muscle flap advancement was decided by correction state of lateral muscle bulging. Correction of nostril floor depression or whistle deformity was also performed with preserved scar flap, if necessary. RESULTS: Realignments of orbicularis oris muscle were possible in the majority of the patients and final results of philtral reconstruction were satisfactory mostly. Correction of nostril floor depression and whistle deformity was also achieved. Additional correction was performed later to 4 patients in whom insufficient reconstruction was noted. No significant complication was observed. CONCLUSION: More natural and symmetric philtrum was acquired with overlapping of orbicularis oris muscle flap. To the authors' knowledge, it is an easy and effective method for correction of philtral deformity through anatomical rearrangement of distorted orbicularis oris muscle with relatively simple procedure.
Cicatrix ; Cleft Lip ; Congenital Abnormalities ; Depression ; Floors and Floorcoverings ; Humans ; Lip ; Muscles ; Nose ; Singing

PURPOSE: Sunken eyelid is a deformity of upper eyelid due to atrophy of periocular fat tissue, loss of skin elasticity. It causes the skin retraction of eyelid and unfavorable fold. Sunken eyelid occurs from the results of natural aging process, facial trauma, complication of previous periocular surgery, etc. We acquired a satisfied correction of sunken eyelid and unfavorable fold using autologous fat injection only. The aim of this study is a assessment of autologous fat injection for correction of sunken eyelid accompanied with unfavorable fold. METHODS: From August 2002 to March 2006, we performed 37 cases of correction of sunken eyelid with unfavorable fold using autologous fat injection. They were all females with ages ranged from 23 to 63. Fat was harvested from lower abdomen and centrifuged with Coleman system. Multi-layered injection of purified fat was done from orbital fat layer to orbicularis oculi muscle. RESULTS: Overall, improvement of sunken eye and unfavorable fold was observed in the majority of the patients. Discomfort of eye opening was improved in 24 patients. The average injection volume was 1.33mL in right eyelid, 1.31mL in left eyelid at first injection. Second injection was done in patients who absorption of injected fat was noted with. No specific complications were observed. CONCLUSION: Natural and attractive upper eyelid was acquired from fat injection only in sunken eyelid with unfavorable fold. To the authors' knowledge, it is desirable for sunken eyelid accompanied with unfavorable fold to be treated with autologous fat injection at first. Although some shortcomings are substantial, autologous fat injection is easy and effective method for correction of unfavorable fold in sunken eyelid without specific complication.
Abdomen ; Absorption ; Aging ; Atrophy ; Congenital Abnormalities ; Elasticity ; Eye ; Eyelids ; Female ; Humans ; Orbit ; Skin

This study was performed to compare the effect of external ultrasound assisted PAL(power assisted liposuction) with that of PAL alone. We performed 17 cases of liposuction from January 2003 to June 2003. For comparing both systems, we treated the right side(study group) with external ultrasound assisted PAL and the left side(control group) with PAL alone. To evaluate the difference in results between two groups, we surveyed three objective and four subjective items. Objectives were categorized as "Reduction rate of postoperative swelling", "Efficiency of suction" and "Histologic finding of aspirated fat tissue". Subjectives were also filed as "Degree of postoperative bruising", "Cannula resistance that operator felt", "Degree of postoperative pain" and "Patient's satisfaction". We assessed by questionnaire three times at 1day, 7 days and 30 days after operation. There were statistically significant differences in two of the subjective items; "Degree of postoperative pain at postoperative 1 day" and "Cannula resistance that operator felt". This study concludes that external ultrasound PAL is more effective high mobility of fat tissue and low tension of surrounding tissue. External ultrasound PAL will be more useful in case of large volume liposuction and revision procedures.
Lipectomy ; Pain, Postoperative ; Questionnaires ; Ultrasonography*

We replaced anesthesia of operations, which has done under local or general anesthesia, by MAC(monitored anesthesia care) with various patient's monitoring devices such as BIS(bispectral index). From April 2003 to March 2004, 48 cases of operations were done in MAC with supplemental equipments. Induction, maintenance of anesthesia was performed by propofol and midazolam. Pain control was done by fentanyl and ketamine. For monitoring the depth of anesthesia in real time, and BIS scale was checked and was maintained in 40-60. All anesthesias were done by the anesthesiologist that was communicated with operator for information between patient's status and operation procedures. All operations and anesthesias progressed with stability and safety, and there was no major postoperative complication. Because BIS was relatively accurate device, there was no over dose of anesthetic agents, which was induced by patient's uncertain pain complain under sedation and no anxiety of operator, that was raised by no responsive patient. BIS made possible that operation under MAC was effective and safe, operator perform it with non-stress condition and followed by good surgical result.
Anesthesia* ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Anxiety ; Conscious Sedation* ; Fentanyl ; Humans ; Ketamine ; Midazolam ; Postoperative Complications ; Propofol ; Spectrum Analysis ; Surgery, Plastic*

Keloids represent a pathological response to injury interrupting skin integrity, creating disfiguring scars with no definitive pathophysiology. Transforming growth factor-beta1(TGF- beta1) has been regarded as one of the pathogenesis of keloids. The purpose of this study is to investigate the influence of keloid keratinocytes on TGF-beta1 expression in co-culture system. Recent studies have highlighted the important concept of epithelial- mesenchymal interactions in normal skin biology, and applying this concept to keloids in vitro studies demonstrated significantly increased proliferation of fibroblasts and collagen production in keloid fibroblasts co-cultured with keloid-derived keratinocytes as compared with normal keratinocytes. In this study, normal or keloid fibroblasts in lower chamber were co-cultured with keratinocytes derived either from normal skin or keloid tissue in upper chamber, separated from lower chamber by permeable membrane. Results obtained by ELISA showed equal TGF-beta1 expression when keloid fibroblasts were co- cultured with keloid keratinocytes, as compared with the normal keratinocytes at 24,48 hours, but significantly higher expression at 72 hours(p=0.0358). RT-PCR demonstrated that the TGF- beta1 expression level was not significantly related to the level of mRNA encoding TGF-beta1. These results suggest that overlying keloid keratinocytes play an important role in inducing high level of TGF- beta1 expression in keloid by paracrine effect or epithelial-mesenchymal interaction.
Biology ; Cicatrix ; Coculture Techniques* ; Collagen ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts* ; Keloid ; Keratinocytes* ; Membranes ; RNA, Messenger ; Skin ; Transforming Growth Factor beta1

To date, for facial soft tissue augmentation, numerous implant materials have been used, including autogenous, homogenous, and alloplastic grafts. Among these, the porous material, Gore-tex(R) has a pore (0.5-30 microns, average 22 microns) which allows sufficient but limited soft tissue ingrowth to anchor implants, but not so much to make removal difficult or destructive to adjacent structures. In addition, this material has some advantage: non-carcinogenic, non-allergic, less capsule formation and reduced chance of infection due to high vascularity. In the past years Gore-tex(R) has found multiple applications in facial plastic and reconstructive surgery. However this alloplastic material can be associated with potentially severe complications and side effects such as soft tissue reaction, infection, extrusion, exposure, etc. There have been also adverse criticism of Gore-tex(R) : relative difficulties in postoperative removal, in carving implant, higher infection and extrusion rates in scarred tissue and thicker implant as well as postoperative volume reduction. In order to analyze results depending on the implantation site, the presence of scar on recipient site, thickness and type of implant, a retrospective chart review of 56 patients(69 cases) was undertaken of all patients who underwent facial soft tissue augmentation with Gore-tex(R) graft from November 1998 to November 2001 in a wide variety of situations. All cases were categorized as either primary(normal recipient site) or secondary(scarred recipient site) cases and the thickness of each graft used in millimeters was recorded. Postoperative follow up revealed a stable implant material with no major complications relating to the graft material and no differences in developing complications according to the implantation site, the presence of scar, thickness and type of implant. All patients were highly satisfied with their results.
Cicatrix ; Follow-Up Studies ; Humans ; Plastics ; Retrospective Studies ; Transplants

Although the incidence of mediastinal wound infection after median sternotomy is relatively low, its associated devastating complications may be life-threatening. Treatment of sterno-mediastinal infection has evolved over the past several decades. Early treatment was wet soaking of debrided wound or irrigation through a closed indwelling catheter system and its mortality was quite high. Subsequent treatments focused on the debridement followed by muscle flaps such as pectoralis major and rectus abdominis muscle flap or by omental flap closure, which were considered as the ideal modalities for acute sterno-mediastinitis. Mortality rate was reduced significantly after application of this active treatment. However, to date, there has been no definite treatment strategy for sterno-mediastinitis and the choice of operations depends largely on the experience and personal preference of the surgeon. So we introduce our experience, including technique and outcome, with transposition of pectoralis major muscle and superiorly-based rectus abdominis muscle turn over flap for deep and extensive sterno-mediastinal wounds. Five patients(3 male and 2 female) had repair of an infected median sternotomy wound from July 2001 to september 2002. Complications after wound closure occured in 2 cases, 1 case of hematoma and 1 case of seroma, respectively. No other major complications have been noted. We treated MRSA or VRE- cultured acute sterno-mediastinitis successfully with early sternal wound debridement and immediate regional muscle flap coverage.
Catheters, Indwelling ; Debridement ; Hematoma ; Humans ; Incidence ; Male ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Rectus Abdominis ; Seroma ; Sternotomy ; Wound Infection ; Wounds and Injuries

Dermatofibrosarcoma protuberans is a slowly growing, locally invasive malignant tumor which originates in the dermis. Clinically, the initial appearance of the tumor is that of an indurated plaque which subsequently gives rise to multiple nodules. In the tumor's later stages, however, its growth rate accelerates, and it can ulcerate, bleed or become painful. but, metastasis is very rare. Dermatofibrosarcoma protuberans occurs most frequently on the trunk and proximal parts of the limbs, less commonly in the head and neck region, and only rarely in the extremities and external genitalia. A characteristic feature of dermatofibrosarcoma protuberans is the tendency to recur locally. This is apparently due to the infiltrative growth pattern between collagen bundles. Therefore, a wide excision is treatment of choice. Skin grafting is the usual reconstructive procedure, but flap reconstructions are used for cosmetic and functional concerns in many anatomic locations. We report the case of wide atrophic dermatofibrosarcoma protuberans and the clinical usefulness of the expanded cutaneous flap using tissue expander in reconstruction of the tissue deficit after wide and deep excision of dermatofibrosarcoma protuberans of the chest and anterior neck.
Collagen ; Dermatofibrosarcoma* ; Dermis ; Extremities ; Genitalia ; Head ; Neck ; Neoplasm Metastasis ; Skin Transplantation ; Thorax ; Tissue Expansion Devices* ; Ulcer

BACKGROUND: To reduce massive blood loss during a hepatectomy, many anesthesiologists have used the technique of low central venous pressure maintenance by administration of low dose nitroglycerin (NTG) and/or intravenous fluid reduction. However, so far there have been no studies about local liver perfusion (LLP) changes after hepatic artery (HA) or portal vein (PV) reperfusion in patients receiving nitroglycerin administration. In this study, the changes in hemodynamics and LLP following HA and PV reperfusion along with low dose (2micro gram/kg/min) NTG administration in dogs were observed. METHODS: A total of 20 mongrel dogs were divided into four groups; HA occlusion and reperfusion group (H, n = 5), NTG administration group during the reperfusion on H (H-NTG, n = 5), PV occlusion and reperfusion group (P, n = 5), NTG administration group during the reperfusion on P (P-NTG, n = 5). After femoral and pulmonary arterial catheterization, a midline abdominal incision was made. HA and PV were exposed to clamp and declamp. A thermal diffusion microprobe was inserted in the liver parenchyme to measure LLP. RESULTS: The PV blood flow was not changed after HA occlusion, but HA blood flow increased after PV occlusion. The LLP decreased after HA and PV occlusion. The LLP recovered to the baseline level in group H-NTG after HA reperfusion, but the LLP was more increased compared to the baseline level in group H. In group P, the LLP did not recover after PV reperfusion, but the LLP in group P-NTG recovered to the baseline level after PV reperfusion. CONCLUSIONS: In conclusion, it was observed that the LLP recovered to the baseline level by administration of NTG after PV reperfusion. However, the LLP did not increase after HA reperfusion by administration of low dose NTG.
Animals ; Catheterization ; Catheters ; Central Venous Pressure ; Dogs* ; Hemodynamics* ; Hepatectomy ; Hepatic Artery* ; Humans ; Liver* ; Nitroglycerin* ; Perfusion* ; Portal Vein* ; Reperfusion* ; Thermal Diffusion